Population-based data from Olmsted County finally give a usable number for how often a seronegative RA diagnosis turns out to be something else: about 13% over ten years, front-loaded into the first five, and most often spondyloarthritis. A quarter achieve sustained drug-free remission lasting a median of 6.3 years, one in five needs a biologic — and nothing measured at baseline predicts which.
Relapsing polychondritis is not one disease with variable severity. A French cohort splits it into three clusters whose mortality runs 4%, 13% and 58% — and the worst cluster is almost certainly VEXAS, which this review argues should be treated as a disease mimic rather than a subtype. Chondritis is absent at presentation in 40%, there is no confirmatory test, and no randomised trial has ever been conducted.
Secukinumab doubled sustained remission at 52 weeks in relapsed polymyalgia rheumatica — 41% versus 20% on a prednisone taper alone — and halved the need for escape steroid. But 150 mg worked as well as 300 mg, the component data show the drug maintains remission rather than inducing it, and roughly six in ten treated patients still did not reach the endpoint.
ACPA-positive and ACPA-negative RA take the same total time from first symptom to arthritis — but split it in mirror image. Seropositive patients reach the rheumatologist later and convert faster; seronegative patients arrive sooner and linger, leaving roughly twice as long an actionable window once they are in front of you. Each entity carries its own signature before arthritis exists.
A 2026 review of cutaneous lupus therapeutics, now organised almost entirely around the type I interferon axis — from TLR7/8 and pDCs through IFNAR to TYK2 — alongside the practical foundation of photoprotection, early hydroxychloroquine and smoking cessation. No therapy is yet FDA-approved specifically for CLE, and almost all evidence is borrowed from SLE trials where skin was a secondary endpoint.
ADVANCE OUTCOMES is a phase 3 trial of once-daily oral ralinepag, a prostacyclin IP receptor agonist, added to background therapy in pulmonary arterial hypertension. It cut first clinical worsening by 55% (HR 0.45) — but the effect was carried entirely by softer composite components, with death and hospitalisation unchanged, and 19% discontinued for adverse events. CTD-PAH made up 29% of the cohort as a prespecified stratum.
A 2026 Personal View arguing that ‘seronegative’ usually describes the assay rather than the patient — and that separating genuinely seronegative disease (myeloid/CD8-driven, MHC class I-associated, rituximab-unresponsive) from merely undetected seropositivity is the field’s necessary next step. Includes a disease-by-disease audit of seronegativity rates and why classification criteria naming the antibody but not the method matters.
Final 24-month data from APPLAUSE-IgAN: the oral factor B inhibitor iptacopan roughly halved the rate of eGFR decline in high-risk IgA nephropathy (−3.10 vs −6.12 ml/min/1.73 m²/year) and cut hard kidney-failure events from 33.5% to 21.4%, converting an accelerated approval based on proteinuria into evidence on preserved kidney function — with serious infection the trade-off to manage.
A 2026 overview of drug- and vaccine-induced ANCA-associated vasculitis — clinically near-indistinguishable from idiopathic AAV, but with a recognisable serological fingerprint (dual MPO/PR3 positivity, elastase-ANCA, high IgM MPO-ANCA, low C4, neutropenia), a milder course, and one intervention no immunosuppressant can substitute for: stopping the drug. Antithyroid drugs, hydralazine and levamisole-adulterated cocaine dominate practice.
Five-year data from the TREAT EARLIER trial show that a time-limited intervention (one glucocorticoid injection plus 12 months of methotrexate) in clinically suspect arthralgia produced durable benefit in ACPA-negative individuals at increased risk — RA in 9% vs 32%, NNT 4 — but nothing lasting in ACPA-positive individuals, splitting the at-risk phase into two diseases with two different answers.